Healthcare Provider Details

I. General information

NPI: 1063054831
Provider Name (Legal Business Name): GLENN MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2019
Last Update Date: 06/18/2024
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 W SYCAMORE ST
WILLOWS CA
95988-2601
US

IV. Provider business mailing address

1133 W SYCAMORE ST
WILLOWS CA
95988-2601
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number
License Number State

VIII. Authorized Official

Name: TAMMY THOMPSON
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 209-287-6308